Bacterial meningitis due to the Streptococcus mitis group in children with cerebrospinal fluid leak
Haruka Fukayama,
Kensuke Shoji,
Michiko Yoshida,
Hiroyuki Iijima,
Takanobu Maekawa,
Akira Ishiguro,
Isao Miyairi
Affiliations
Haruka Fukayama
National Center for Child Health and Development, Department of General Pediatrics and Interdisciplinary Medicine, Tokyo, Japan; National Center for Child Health and Development, Center for Postgraduate Education and Training, Tokyo, Japan
Kensuke Shoji
National Center for Child Health and Development, Division of Infectious Diseases, Department of Medical Subspecialties, Tokyo, Japan; Correspondence to: Division of Infectious Diseases, Department of Medical SubspecialtiesNational Center for Child Health and Development, 2–10-1 Okura, Setagaya-ku, Tokyo 157–8535, Japan.
Michiko Yoshida
National Center for Child Health and Development, Division of Infectious Diseases, Department of Medical Subspecialties, Tokyo, Japan
Hiroyuki Iijima
National Center for Child Health and Development, Department of General Pediatrics and Interdisciplinary Medicine, Tokyo, Japan
Takanobu Maekawa
National Center for Child Health and Development, Department of General Pediatrics and Interdisciplinary Medicine, Tokyo, Japan
Akira Ishiguro
National Center for Child Health and Development, Center for Postgraduate Education and Training, Tokyo, Japan
Isao Miyairi
National Center for Child Health and Development, Division of Infectious Diseases, Department of Medical Subspecialties, Tokyo, Japan
The Streptococcus mitis group constitutes a part of the oral flora in humans and has been reported to cause infective endocarditis, brain abscesses, sepsis, pneumonia, and peritonitis. However, the S. mitis group rarely causes meningitis in children. We experienced a case of bacterial meningitis due to the S. mitis group in a 14-year-old girl with Gorham-Stout disease undergoing treatment with sirolimus for skull base osteolysis and cerebrospinal fluid (CSF) leak. Antibiotic treatment was initiated with linezolid and levofloxacin due to allergies against β-lactam antibiotics. On the third treatment day, antibiotics were switched to penicillin G according to CSF culture results, which were positive for penicillin-susceptible S. mitis group. Antibiotic therapy was successfully completed after 14 days without any neurological sequelae. There have apparently been no reports of S. mitis meningitis in pediatric patients with skull base osteolysis and CSF leak as in our case. Our findings suggest that clinicians should be aware of the possibility of S. mitis meningitis for patients with skull base osteolysis and/or CSF leakage.
